[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-detail-161363-en":53,"doc-seo-161363-105":75},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":5,"data":54},{"doc_id":55,"user_id":56,"nickname":57,"user_avatar":58,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":60,"doc_content":61,"file_id":62,"file_url":63,"file_type":64,"file_size":65,"view_count":66,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":67,"language":68,"language_code":69,"site_id":70,"html_lang":69,"table_of_contents":71,"faqs":72,"seo_title":73,"seo_description":60,"update_tm":74,"read_time":9},161363,8796095360427,"Lucas Martin","https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","THP Letter of Support Template","Letter of support template for clinician use to document a client’s readiness and appropriateness for gender-affirming surgical intervention. Collects required identity and contact details, confirms licensing status, and records clinician assessments, dates evaluated, hormone history, and adherence to standards such as living in a congruent gender role for 12 continuous months. Captures consent capacity, communication needs, mental health and risk factors, medication and substance use plans, housing and recovery barriers, support system, and aftercare capability to help guide referral decisions.","\u0003Client’s name: \u0003Click or tap here to enter text.\u0004\nLegal name if different: \u0003Click or tap here to enter text.\u0004\nPatient’s pronoun: \u0003Click or tap here to enter text.\u0004\nDOB: \u0003Click or tap here to enter text.\u0004\u0004\n\u0003Clinician Name: \u0003Click or tap here to enter text.\u0004\nOffice/Agency location or clinic:  \u0003Click or tap here to enter text.\u0004\nPhone number of clinician: \u0003Click or tap here to enter text.\u0004\nAre you licensed?     \u0003\u0003☐\u0004 Yes        \u0003☐\u0004 No\u0004  (Assessments must be completed or attested to by a licensed providers.) \u0004\n\u0003Please describe your experience completing assessments for gender related surgeries:\n\u0003Click or tap here to enter text.\u0004\u0004\n\u0003This is a:\n\u0003☐\u0004  Single assessment or first assessment (breast or chest surgery requires one assessment)\n\u0003☐\u0004  Second assessment (hysterectomy, oopherectomy, orchiectomy, vaginoplasty, vulvoplasty, metiodioplasty, pahlloplasty requies two assessments)\u0004\n\u0003For which surgery/surgeries are you referring your client?\n\u0003☐\u0004  Orchiectomy\n\u0003☐\u0004  Hysterectomy/Oophorectomy\n\u0003☐\u0004  Vaginoplasty/Vulvoplasty\n\u0003☐\u0004  Breast augmentation\n\u0003☐\u0004  Mastectomy with chest reconstruction\n\u0003☐\u0004  Phalloplasty\n\u0003☐\u0004  Metoidioplasty\n\u0003☐\u0004  A surgery not listed here. Please describe: \u0003Click or tap here to enter text.\u0004\u0004\n\u0003Please list the dates that you evaluated this client for readiness and appropriateness for surgical intervention:\u000b\u0003Click or tap here to enter text.\u0004\u0004\n\u0003Please give a description of this client, identifying characteristics, age, ethnicity, language, gender identity, etc., and their history of gender dysphoria and emphasize their attempts to address their gender dysphoria.\u000b\u0003Click or tap here to enter text.\u0004\u0004\n\u0003Please indicate the length of time your client has taken hormones. How do they describe their response to hormones?  (e.g., decreased dysphoria, could not tolerate them, etc.)\u000b\u0003Click or tap here to enter text.\u0004\u0004\n\u0003For patients considering vaginoplasty, orchiectomy, hysterectomy, metoidioplasty, and phalloplasty: The Standards of Care states that the client must have “12 continuous months of living in a gender role that is congruent with their gender identity.” Please describe how the client has met this standard:\u000b\u0003Click or tap here to enter text.\u0004\u0004\n\u0003Please describe your rationale for the referral for surgery at this time:\u000b \u0003Click or tap here to enter text.\u0004\u0004\n\u0003Does this client have the capacity to give informed consent for surgery?  If no or limitations, please explain:\u000b\u0003Click or tap here to enter text.\u0004\u0004\nAre there issues the surgeon(s) need to know about regarding communication? These could include English fluency, hearing impairments, autism spectrum, literacy level, learning differences, etc.:\u000b\u0003Click or tap here to enter text.\u0004\nFor each surgery your client is requesting, please describe how each surgery will improve your client's functioning. How will it make their life better? Please use the client's words:\u000b\u0003Click or tap here to enter text.\u0004\nIf client is referred for facial gender confirmation, please specify how dysphoria related to their facial features affects their daily life and what impact that has on the client’s potential or current psychiatric comorbidities. Please use client’s words and be very specific:\u000b\u0003Click or tap here to enter text.\u0004\nDescribe how your client has approached educating themselves about the surgery/surgeries they are seeking (e.g., spoke with peers, attended patient education session at OHSU, internet research, prior consult with a surgeon, explanation by PCP, etc.):\u000b\u0003Click or tap here to enter text.\u0004\nDoes your client have a mental health diagnosis or history that the stress of surgery, anesthesia, or recovery that may cause your client to have an exacerbation of symptoms or become destabilized? For instance: PTSD, anxiety disorders, depression, bipolar disorder, schizophrenia, substance abuse, etc.:\u000b\u0003Click or tap here to enter text.\u0004\nPlease describe how you have prepared your client for this possibility and how this will be addressed:\u000b\u0003Click or tap here to enter text.\u0004\nPlease list all medications that th","cbCaib9LFhzVlewS","https://ap.wps.com/l/cbCaib9LFhzVlewS","docx",59956,6,3,"English","en",105,"# Client and clinician information\n## Assessment context and licensing\n# Surgical request and readiness criteria\n## Target surgery/surgeries\n## Dates evaluated and standards met\n## Hormones and response\n## Referral rationale and informed consent\n# Psychosocial, medical, and recovery planning\n## Communication needs\n## Mental health history and preparation\n## Medications and substance use\n## Nicotine and substance reduction plans\n## Housing, support system, aftercare capability","[{\"question\":\"What information does the template collect about the client and clinician?\",\"answer\":\"It captures the client’s name, legal name (if different), pronouns, date of birth, and details about the clinician including name, location/clinic, and phone number, plus licensing status.\"},{\"question\":\"How does the template document readiness for surgery?\",\"answer\":\"It requests assessment dates, a description of the client’s characteristics and gender dysphoria history, hormone use duration and response, and an explanation of how the client meets the 12 continuous months of living in a congruent gender role standard.\"},{\"question\":\"What recovery-related and risk factors are required?\",\"answer\":\"It gathers the client’s mental health diagnosis/history, relevant medications, nicotine and substance use reduction plans, housing arrangements after surgery, support system details, communication considerations, and whether the client can carry out the aftercare plan.\"}]","THP Letter of Support Template | DOCX",1788098204,{"code":4,"msg":76,"data":77},"ok",{"site_id":70,"language":69,"slug":78,"title":59,"keywords":79,"description":60,"schema_data":80,"social_meta":135,"head_meta":137,"extra_data":139,"updated_unix":74},"thp-letter-of-support-template","",{"@graph":81,"@context":134},[82,97,117],{"@type":83,"itemListElement":84},"BreadcrumbList",[85,89,92,94],{"item":86,"name":87,"@type":88,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":90,"name":10,"@type":88,"position":91},"https://docshare.wps.com/template/",2,{"item":93,"name":41,"@type":88,"position":67},"https://docshare.wps.com/template/letters/",{"item":95,"name":59,"@type":88,"position":96},"https://docshare.wps.com/template/thp-letter-of-support-template/161363/",4,{"url":95,"name":59,"@type":98,"image":99,"author":104,"headline":59,"publisher":106,"fileFormat":109,"inLanguage":69,"description":60,"dateModified":110,"datePublished":111,"encodingFormat":109,"isAccessibleForFree":112,"interactionStatistic":113},"DigitalDocument",{"url":100,"@type":101,"width":102,"height":103},"https://docshare.wps.com/thumbnails/thp-letter-of-support-template/161363.png","ImageObject",442,249,{"name":57,"@type":105},"Person",{"url":86,"name":107,"@type":108},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-27","2026-08-30",true,{"@type":114,"interactionType":115,"userInteractionCount":66},"InteractionCounter",{"@type":116},"ViewAction",{"@type":118,"mainEntity":119},"FAQPage",[120,126,130],{"name":121,"@type":122,"acceptedAnswer":123},"What information does the template collect about the client and clinician?","Question",{"text":124,"@type":125},"It captures the client’s name, legal name (if different), pronouns, date of birth, and details about the clinician including name, location/clinic, and phone number, plus licensing status.","Answer",{"name":127,"@type":122,"acceptedAnswer":128},"How does the template document readiness for surgery?",{"text":129,"@type":125},"It requests assessment dates, a description of the client’s characteristics and gender dysphoria history, hormone use duration and response, and an explanation of how the client meets the 12 continuous months of living in a congruent gender role standard.",{"name":131,"@type":122,"acceptedAnswer":132},"What recovery-related and risk factors are required?",{"text":133,"@type":125},"It gathers the client’s mental health diagnosis/history, relevant medications, nicotine and substance use reduction plans, housing arrangements after surgery, support system details, communication considerations, and whether the client can carry out the aftercare plan.","https://schema.org",{"og:url":95,"og:type":136,"og:title":59,"og:site_name":107,"og:description":60},"article",{"robots":138,"canonical":95},"index,follow",{"doc_id":55,"site_id":70}]